REPUBLIC OF THE PHILIPPINES )

___________________________ ) S.S

AFFIDAVIT OF LOSS

I, KENNETH JOHN M. ABINAL, Filipino, married, of legal age, and with residence and postal
address at 38 Berospe St., Manresa, BF Homes, Paranaque City, after having been duly sworn in accordance
with law, hereby depose and state that:

1. I am a Technical Analyst at Optum. As an employee of the said corporation, I was issued

a Company Identification Card and Badge.

2. Sometime in November 2018, when I arrived home from work, I discovered that the said
Company Identification Card and Badge was no longer in the place where I used to place it.

3. Despite diligent search and efforts exerted to look for the said Company ID and Badge, the
same could no longer be found.

4. The said documents were not confiscated by any government authorities and that the same
were in fact, truly lost.

5. I execute this affidavit to attest the veracity and truthfulness of the foregoing declaration
and to be used for whatever legal intent and purposes the same may be served.

IN WITNESS WHEREOF, I have hereunto set my hand this _____th day of

___________________________ 2018 at _____________________.

_______________________________
KENNETH JOHN M. ABINAL
Affiant

SUBSCRIBED AND SWORN TO before me this _________ of __________________________

2018 at ______________________, affiant exhibiting to me the following competent evidence of his
identity: _________________________, bearing her signature and photograph.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.